A Matched Case-Case-Control Study of the Impact of Clinical Outcomes and Risk Factors of Patients with IMP-Type Carbapenemase-Producing Carbapenem-Resistant <i>Enterobacteriaceae</i> in Japan
Sho Saito, Kayoko Hayakawa, Shinya Tsuzuki, Masahiro Ishikane, Maki Nagashima, Kazuhisa Mezaki, Yuko Sugiki, Taichi Tajima, Nobuaki Matsunaga, Satoshi Ide, Noriko Kinoshita, Yoshiki Kusama, Yumiko Fujitomo, Takato Nakamoto, Yuta Toda, Mitsuo Kaku, Eiichi Kodama, Norio Ohmagari
Abstract
sp. isolates) were included. The IMP-11 type was present in 43 patients, IMP-1 in 33, and IMP-60 and IMP-66 in 1 each; 31 patients with CRE (32.3%) and 34 with CSE (35.4%) developed infections. Multivariate analysis identified the following independent risk factors: gastrostomy, history of intravenous therapy or hemodialysis, and previous exposure to broad-spectrum β-lactam antibiotics, including penicillin with β-lactamase inhibitors, cephalosporins, and carbapenems. In propensity score-adjusted analysis, mortality rates for the CRE and CSE groups were similar (15.0% and 19.5%, respectively). We found that IMP-CRE may not contribute to worsened clinical outcomes, compared to CSE, and gastrostomy, previous intravenous therapy, hemodialysis, and broad-spectrum antimicrobial exposure were identified as risk factors for CRE isolation. Fluoroquinolone and aminoglycosides are potentially useful antibiotics for IMP-CRE infections.